后踝骨折对关节面损伤程度影响的三维形态学评估及其临床意义  

Three-dimensional measurement of articular surface injury severity due to posterior malleolus fracture

作　　者：陈雁西[1] 张坤[1] 强敏菲[1] 李浩博[1] 姜雨晨[1] 

机构地区：[1]同济大学附属东方医院创伤骨科,上海200120

出　　处：《中华创伤杂志》2015年第2期111-116,共6页Chinese Journal of Trauma

基　　金：国家自然科学基金资助项目（81271989,81370053）

摘　　要：目的 基于CT三维重建技术,创建一项后踝骨折对关节面损伤程度影响的精准评估方法并探讨其临床意义. 方法 2009年5月-2014年3月收治138例踝关节周围损伤伴后踝骨折患者.在踝关节侧位X线片上,应用传统测量方法测量后踝骨折块占胫骨远端关节面的比值;基于16排螺旋CT数据后处理技术,应用三维重建图像测量损伤面积的比值.采用配对样本t检验分析观察者内/间一致性组内相关系数（ICC）. 结果 按预设测量方案,本组33例踝关节侧位X线片及13例CT三维重建图像上无法实施有效测量,共对98例进行了X线片与CT三维重建图像测量数据的有效对比分析.X线片上后踝骨折块占关节面比值为（16.2±7.2）％,CT三维重建图像上测量结果为（29.6±10.1）％（P＜0.05）.X线片的观察者内/间一致性检验ICC为0.875/0.860,CT三维重建图像为0.973/0.942,CT三维重建图像测量结果一致性均高于X线片测量结果. 结论 CT三维重建测量评估后踝骨折对关节面损伤程度的影响是可靠且可重复的,X线片评估后踝骨折块的大小会低估其实际损伤程度,影响手术指征的选择.Objective To establish a way to measure the injury severity of articular surface due to posterior malleolus fracture and investigate its clinical significance based on three-dimensional reconstruction technique.Methods Between May 2009 and March 2014,138 cases of peri-ankle injury combined with posterior malleolus fracture were treated.Lateral radiographs were reviewed to measure the ratio of posterior fragment area to distal tibial plafond area using the common method.Three-dimensional CT images were examined to measure ratio of the area of injury using the three-dimensional measuring method.Statistical comparison was made using the t-test and intraclass correlation coefficient （ICC）.Results Measurement failed on 33 lateral radiographs and 13 three-dimensional CT images.Six cases cannot be measured by both imaging technology,so results of 98 cases were compared.Ratio of posterior fragment area to tibial plafond area was （16.2 ± 7.2） % measured by radiographs and was （29.6 ±10.1） % by three-dimensional CT scans （P 〈 0.05）.Three-dimensional CT measurements showed higher intra and inter-observer agreement （ICC of 0.973 to 0.942） than that in radiographic measurements （ICC of 0.875 to 0.860）.Conclusion Three-dimension CT assessment of the extent of injury to articular surface because of posterior malleolus fracture is reliable and reproducible,but radiographic assessment may underestimate the injury and influence the choice of surgical indications.

关 键 词：踝损伤 成像 三维 体层摄影术 X线计算机 

分 类 号：R687.3[医药卫生—骨科学]